Some late-day surgeries as safe as earlier ones

NEW YORK (Reuters Health) - People who have late-day prostate and kidney surgeries fare just as well as those who have their procedures earlier in the day, according to a new study.

Previous research has hinted that morning procedures - including colonoscopies and surgeries to insert a stent - might be safer or more successful than those done later in the day (for example, see Reuters Health report of June 17, 2010).

Surveys have also shown many surgeons get physically and mentally tired - but it hasn't been clear whether this results in worse performance as the day goes on.

"We really didn't find any significant differences one way or another (between early and late surgeries), which is reassuring," said Dr. Yair Lotan, the senior author of the new study from the University of Texas Southwestern Medical Center at Dallas.

In each case, the same type of surgery was performed at least twice in one day by a single surgeon, allowing the researchers to compare outcomes of earlier and later procedures.

Among the 110 surgeries to remove kidney stones, they found no difference in the rates of complications, blood transfusions or stone fragments left behind in patients who had earlier and later procedures. Forty-seven out of 55 patients who went first ended up being free of kidney stones after surgery, compared to 49 out of 55 who had late-day procedures.

For both standard and robot-assisted prostate cancer surgery, patients fared just as well whether they were scheduled to be the first prostate removal of the day or the second.

For instance, 58 percent of men who had standard, minimally-invasive surgery first on any given day remained continent after surgery, compared to 61 percent of men who had the procedure second.

Similarly, among men who had robot-assisted prostate surgery, 45 percent who had earlier procedures and 48 percent who had later ones remained continent afterward.

The researchers concluded that any differences between the patient groups were likely due to chance, rather than the timing of their surgeries.

Early and late prostate procedures were also just as likely to successfully remove the cancer.

Lotan and his colleagues write in their report in The Journal of Urology that "patients can be encouraged that a later operative start time does not equate to a worse outcome."

The study could not explain why certain other procedures, such as colonoscopy, seem to be affected by the time of day they're performed.

Doctors tend to catch more polyps during morning colon cancer screenings than in the afternoon, according to earlier reports.

Lotan said that during colonoscopy, physicians don't know when they've missed a polyp, perhaps making the procedure more prone to the influence of fatigue.

Surgery, on the other hand, involves a series of steps that are difficult to overlook.

Lotan also said that the environment of surgery - being surrounded by bright lights, standing up while operating and having an assistant - contributes to surgeons maintaining their performance as the day progresses.

The study doesn't show surgeons are immune to fatigue, "but it does mean there are ways to compensate," he told Reuters Health.

"Surgeons are trained to provide the sufficient level of attention so their outcomes are no different" depending on the time of day, Lotan added.